Robotic Rectal Cancer Surgery: Current Controversies

This review evaluates the current literature on robotic surgery for rectal cancer and discusses ongoing controversies related to outcomes, training, adoption, and cost-effectiveness. Robotic rectal surgery is associated with some benefits in short-term outcomes such as lower conversions compared to laparoscopy but also substantially higher costs. Data on long-term oncologic outcomes are still limited. Studies are inconsistent regarding benefits in margin positivity and other metrics. There is significant variability in training practices and adoption rates globally. Robotic rectal surgery is increasingly utilized, especially for low rectal cancers where laparoscopy is more challenging. It allows more patients to undergo minimally invasive total mesorectal excision. However, benefit over laparoscopy is unclear for less complex cases. Ongoing controversies exist related to true outcomes, optimal training, cost-effectiveness, and credentialing of surgeons. Further data from high-quality trials are needed to better determine the definitive role of robotic platforms.